Rejected

When the entire hepatic pedicle is invaded by a tumour, the treatment of cholestasis represents a challenge both for choosing the best drainage possibility and for performing the liver haemostasis during a surgical procedure. Case Report: A patient with progressive jaundice resulting from a remaining gastric tumour that invaded the gallbladder and the hepatic pedicle was successfully treated with biliary decompression using the omega hepaticojejunal shunt. The minor parenchymal bleeding was achieved with the electrocautery greased with lidocaine gel. When burned by the electrocautery, the lidocaine gel made a sealing crust that recovered all the liver parenchyma. Efficacious and stable haemostasis was immediately achieved. The patient had an uneventful early postoperative follow-up, and all cholestasis manifestations, including jaundice and pruritus, decreased since the first day. The patient survived nine months with asymptomatic low jaundice. Conclusion: In the presence of general involvement of the bile ducts, the omega hepaticojejunal shunt reduces the manifestations of cholestasis and improves the patient's quality of life. The electrocautery greased with lidocaine gel is inexpensive, easily available and efficacious method to achieve immediate hepatic haemostasis.

Trigeminal neuralgia is a common neuropathic pain in the head and face. The pathogenesis of trigeminal neuralgia is complex, and so far, the pathogenesis of trigeminal neuralgia involving peripheral and central nervous inflammation theory has not been explained clearly. The loss of dopamine neurons in striatum may play an important role in the development of trigeminal nerve, but the reason is not clear. C-Abl is a nonreceptor tyrosine kinase, which can be activated abnormally in the environment of neuroinflammation and cause neuron death. We found that in the rat model of infraorbital nerve ligation trigeminal neuralgia, the pain threshold decreased, the expression of c-Abl increased significantly, the downstream activation product p38 was also activated abnormally and the loss of dopamine neurons in striatum increased. When treated with imatinib mesylate (STI571), a specific c-Abl family kinase inhibitor, the p38 expression was decreased and the loss of dopaminergic neurons was reduced. The mechanical pain threshold of rats was also improved. In conclusion, c-abl-p38 signaling pathway may play an important role in the pathogenesis of trigeminal neuralgia, and it is one of the potential targets for the treatment of trigeminal neuralgia.

Our goal is to review current literature regarding drug-induced acute angle-closure glaucoma (AACG) and provide ophthalmologists and general practitioners with a thorough understanding of inciting medications and treatment pitfalls to be avoided.

Blood transfusion is not without harm, and recent studies suggest association between transfusion and poor outcome in critically ill patients. Although it is prescribed for many reasons based on the firm belief that blood transfusion improves oxygen carrying capacity, it carries notable adverse hazards. Importantly, lung surgeries are counted as moderate to high-risk operations and take a significant risk of blood loss.

Postherpetic neuralgia (PHN) refers to the chronic neuropathic pain that persists beyond the initial varicella-zoster rash. Patients with chronic lymphocytic leukemia (CLL) are susceptible to infections because of decreased immunity. Various treatment strategies including pharmacological, nonpharmacological, and interventional techniques have been described in the literature. We report the successful management of PHN with lumbar erector spinae plane block in a patient of CLL.

Although migraine is common, there are very few treatment options. Recently, lasmiditan, a specific 5-HT agonist, has gained approval as abortive therapy for migraine. This meta-analysis and trial sequential analysis (TSA) was performed to analyze efficacy and tolerability of lasmiditan therapy for episodic migraine.

Stroke is the development of a focal neurological disturbance lasting >24 h, of vascular origin. In India, stroke is one of the leading causes of morbidity and mortality. Most stroke patients, during their duration of treatment and posthospitalization, want relief of suffering, a sense of control and minimized burden on the family.

Inadequate pain management and undertreatment remain a serious clinical issue among hospitalized adults, contributing to chronic pain syndromes and opioid dependency. Implementation of individual pain care interventions has been insufficient to improve pain care quality. The purpose of this interprofessional, patient-centered project was to implement a 6-component bundle of evidence-based pain management strategies to improve patients' perception of pain care quality and 24-hour pain experience outcomes. A quasi-experimental design was used to test the effect of a bundled pain management intervention on 3 medical surgical units. Baseline outcomes using the Pain Care Quality-Interdisciplinary (PainCQ-I) and Pain Care Quality-Nursing (PainCQ-N) surveys were measured monthly for 4 months preintervention and 30 months postintervention. A convenience sample of 846 patients was analyzed. The effect of the intervention on pain outcomes could not be tested because unit-based adherence did not meet the goal of 80%. A subsample of 70.2% (594/846) of participants was sufficient to complete a 3-group analysis of preintervention and postintervention participants with confirmed intervention adherence. Participants in the postintervention group who received all 6 components (n=65) had significantly higher odds of higher PainCQ scores than those in the preintervention group (n=141) (PainCQ-I: odds ratio [OR] 2.61, 95% confidence interval [CI] 1.54-4.42; PainCQ-N: OR 3.82, 95% CI 2.06-7.09) or those in the postintervention group receiving ≤5 components (n=388) (PainCQ-I: OR 2.52, 95% CI 1.57-4.03; PainCQ-N: OR 3.84, 95% CI 2.17-6.80). Medical surgical patients participating in this study who received the bundled 6-component intervention reported significantly higher levels of perceived pain care quality, suggesting that a bundled approach may be more beneficial than unstandardized strategies.